Homelessness Prevention Programs Research Articles

Latino-Hispanic Unsheltered Homelessness Before and After COVID-19.

Objectives. To identify sociodemographic shifts among unsheltered Latino people experiencing homelessness (PEH) between 2020-2022. Methods. We examined differences in characteristics reported in demographic surveys for Latino PEH older than 25 years from 2020 (n = 1215) and 2022 (n = 1395) in Los Angeles County, California, using weighted bivariate χ2 tests. Results. From 2020 to 2022, there was a 25% increase in the number of unsheltered Latino individuals. The share of Latino PEH who were unemployed increased (57% to 67%). The increase in homelessness occurred largely among individuals living in vehicles (14% to 33%), rather than in tents or on sidewalks. Latino PEH were significantly less likely to report mental illness (24% vs 18%) and had higher rates of first entry into homelessness in the past 2 years than non-Latino respondents. Conclusions. Our results are consistent with the effects of increasing socioeconomic vulnerability, likely related to COVID-19, in driving the increase in Latino PEH. Policy Implications. The rise in homelessness among economically vulnerable yet healthy Latinos suggests a need to bolster social safety nets and increase homelessness prevention programs. (Am J Public Health. 2024;114(S6):S510-S514. https://doi.org/10.2105/AJPH.2024.307717) [Formula: see text].

Do Homelessness Prevention Programs Prevent Homelessness? Evidence from a Randomized Controlled Trial

Abstract This paper provides the first evidence from a randomized controlled trial isolating the impact of financial assistance to prevent homelessness. In this study individuals and families at imminent risk of homelessness were offered temporary financial assistance, averaging nearly $2,000 for those assigned to treatment. Our results show that this assistance significantly reduces homelessness by 3.8 percentage points from a base rate of 4.1 percent. The effects are larger for people with a history of homelessness and no children. Despite concerns about cost-effectiveness due to difficulty targeting, our estimates suggest that the benefits to homelessness prevention exceed costs.

Reassessing measures of risk for homelessness among families with children in New York City

This study reassessed risks that researchers have identified as predicting homelessness among families in New York City. These risks form the basis of a screening tool called the Risk Assessment Questionnaire (RAQ). It is used by NYC's homelessness prevention program, Homebase, to determine services to provide families. An RAQ score of 7 or above, on a 25-point scale, indicates high risk and greater service needs. This study's logistic regression model identified five indicators that increased odds of shelter entry among 9630 Homebase family clients from 2016 to 2019 (12 % entered shelters): having a child less than two years old; discord with one's landlords; being in an institution, or shelter, recently; and having been in a shelter as an adult; or as a child. This study also identified combinations of client risks, using Latent Class Analysis. Two groups most likely to enter shelters (7.5 % of the sample) also had the highest rates of experiences in institutions or shelters and moving frequently, with one of these registering the highest rate of childhood trauma. This study recommends implementing a state program that covers childcare costs for vulnerable families, which could address risks that children of single mothers face to future instability.

Predictors of homeless service utilization and stable housing status among Veterans receiving services from a nationwide homelessness prevention and rapid rehousing program

Homelessness prevention and rapid rehousing (RRH) programs are increasingly important components of the homeless assistance system in the United States. Yet, there are key gaps in knowledge about the dynamics of the utilization of these programs, with scant attention paid to examining the duration of homelessness prevention and RRH service episodes or to patterns of repeated use of these programs over time. To address these gaps, we use data from the U.S. Department of Veterans Affairs’ (VA) Supportive Services for Veteran Families (SSVF) program—the largest program in the country providing homelessness prevention and RRH services—to assess the relationship between individual and program-level factors and exits to stable housing, length of service episodes, and patterns of repeated service use over time. We analyze data for a primary cohort of 570,798 of Veterans who received SSVF services during Fiscal Years (FY) 2012–2021, and for separate cohorts of Veterans who received SSVF prevention and RRH services, respectively, during FY 2016–2021. We find that participants’ income, indicators of their health status, their use of other VA homeless programs, and rurality are consistent predictors of our outcomes. These findings have implications for how to allocate homelessness prevention and RRH resources in the most efficient manner to help households maintain or obtain stable housing.

ED-Home: Pilot feasibility study of a targeted homelessness prevention intervention for emergency department patients with drug or unhealthy alcohol use.

Housing insecurity is prevalent among emergency department (ED) patients. Despite a surge of interest in screening for patients' social needs including housing insecurity, little research has examined ED social needs interventions. We worked together with government and community partners to develop and pilot test a homelessness prevention intervention targeted to ED patients with drug or unhealthy alcohol use. We approached randomly sampled patients at an urban public hospital ED, May to August 2019. Adult patients were eligible if they were medically stable, not incarcerated, spoke English, had unhealthy alcohol or any drug use, and were not currently homeless but screened positive for risk of future homelessness using a previously developed risk screening tool. Participants received a three-part intervention: (1) brief counseling and referral to treatment for substance use delivered through a preexisting ED program; (2) referral to Homebase, an evidence-based community homelessness prevention program; and (3) up to three troubleshooting phone calls by study staff. Participants completed surveys at baseline and 6 months. Of 2183 patients screened, 51 were eligible and 40 (78.4%) participated; one later withdrew, leaving 39 participants. Participants were diverse in age, gender, race, and ethnicity. Of the 32 participants reached at 6 months, most said it was very or extremely helpful to talk to someone about their housing situation (n=23, 71.9%) at the baseline ED visit. Thirteen (40.6%) said their housing situation had improved in the past 6 months and 16 (50.0%) said it had not changed. Twenty participants (62.5%) had made contact with a Homebase office. Participants shared ideas of how to improve the intervention. This pilot intervention was feasible and well received by participants though it required a large amount of screening to identify potentially eligible patients. Our findings will inform a larger future trial and may be informative for others seeking to develop similar interventions.

Periodic Evaluations of Risk Assessments: Identifying Families for Homelessness Prevention Services

The New York City Homebase program is one of only a few comprehensive U.S. homelessness prevention programs. To ensure that in-depth services are provided to families most at risk of homelessness, Homebase utilizes a structured assessment, the Risk Assessment Questionnaire (RAQ), developed using 2004–2008 data. We evaluated the RAQ’s performance in a more recent cohort of 48,450 families with children applying for Homebase services from 2013 to 2016, testing the predictive power of the current assessment, as well as the power of existing and potential new individual items, using Cox survival models to predict homeless shelter application. The RAQ threshold for in-depth services still effectively identifies shelter risk (13.7%, vs. 5.9% for those below the threshold), suggesting that services are being directed to the highest-risk families. Simulations of a modified RAQ reflecting regression results and program leadership input present assessment adjustments to consider to improve its efficiency and predictive power.

Reassessing Measures of Risk for Homelessness Among Participants of a New York City Homelessness Prevention Program

Reassessing Measures of Risk for Homelessness Among Participants of a New York City Homelessness Prevention Program

Identifying a typology of homelessness based on self-sufficiency: Implications for rapid re-housing interventions.

Limited research exists on the characteristics of individuals experiencing homelessness who achieve positive housing outcomes in rapid re-housing (RRH) interventions. We aimed to identify a typology of homelessness based on Self-Sufficiency Matrix (SSM) domains and examine its relation to sociodemographic characteristics and housing placement through RRH. Homeless Management Information System data, including sociodemographics, SSM domains, and housing outcomes, were obtained for 261 Homelessness Prevention and Rapid Re-housing Program participants in Indianapolis, Indiana, from 2009 to 2012. Latent class analysis (LCA) and latent class regression (LCR) were used to identify subgroups and predict associations between the identified typology and sociodemographic variables and housing placement outcome, respectively. LCA revealed three classes based on SSM domains: "High Self-Sufficiency," "Low Socioeconomic Self-Sufficiency," and "Low Psychosocial Self-Sufficiency." LCR revealed that race significantly predicted class membership such that Black individuals had a significantly higher probability of being in the High Self-Sufficiency class than the other two classes. Latent class membership significantly predicted immediate housing placement. The Low Psychosocial Self-Sufficiency group was the least likely to exit RRH to a permanent housing placement compared to the two other subgroups. Results affirm that individuals with greater psychosocial self-sufficiency have better housing outcomes through RRH than those with more complex support needs. Future research is needed to understand factors influencing differential self-sufficiency, as measured by the SSM, among Black and White individuals.

Homeless Shelter Entry in the Year After an Emergency Department Visit: Results From a Linked Data Analysis

Housing instability is prevalent among emergency department (ED) patients and is known to adversely affect health. We aim to determine the incidence and timing of homeless shelter entry after an ED visit among patients who are not currently homeless. We conducted a random-sample survey of ED patients at an urban public hospital from November 2016 to September 2017. Patients provided identifying information and gave informed consent for us to link their survey data with the New York City Department of Homeless Services shelter database. Shelter use was followed prospectively for 12 months after the baseline ED visit. We examined timing of shelter entry in the 12 months after the ED visit, excluding patients who were homeless at baseline. Of 1,929 unique study participants who were not currently homeless, 96 (5.0%) entered a shelter within 12 months of their baseline ED visit. Much of the shelter entry occurred in the first month after the ED visit, with continued yet slower rates of entry in subsequent months. Patients in our sample who entered a shelter were predominantly men and non-Hispanic black, and commonly had past shelter and frequent ED use. In this single-center study, 5.0% of urban ED patients who were not currently homeless entered a homeless shelter within the year after their ED visit. Particularly if replicated elsewhere, this finding suggests that ED patients may benefit from efforts to identify housing instability and direct them to homelessness prevention programs.

Predictors and correlates of unstable housing experiences among a child welfare-involved sample

ABSTRACTThe study examined whether youth demographics, family factors, and maltreatment type were related to unstable housing and whether unstable housing predicted delinquency and marijuana use. Participants included 216 child welfare-affiliated adolescents (mean age = 18.2 years). Youth with more lifetime residences were more likely to experience unstable housing although Latino youth (compared to White, Black, or multiethnic/biracial) were less likely to experience unstable housing. Unstable housing was associated with subsequent delinquency. Caregiver type (parent vs. relative/unrelated caregiver) was not related to unstable housing, thus homelessness prevention programs should include youth who remain with their parents and those with non-parent caregivers.

Psychometric properties of the self-sufficiency matrix among homeless and vulnerably housed individuals and families.

Homeless service systems have been implementing assessment tools to inform service provision for individuals and families. Although a variety of assessments are available, their psychometric evidence base is limited. The self-sufficiency matrix (SSM) is one assessment that demonstrates promising reliability and validity. However, the SSM's factor structure has been inconsistent across studies. This study explored the factor structure of the SSM, using exploratory factor analysis and confirmatory factor analysis in a sample of individuals (N = 427) and families ( N = 428) at risk of or experiencing homelessness. Data were derived from a midwestern city's Homeless Management Information System and included all participants from the Homelessness Prevention and Rapid Re-Housing Program. Results suggest the SSM is multidimensional and the factor structure differs across individuals and families. Additionally, the SSM demonstrates measurement invariance across racial and gender groups. Further development and testing of the SSM is necessary to better serve individuals experiencing homelessness.

The Impact of Homeless Prevention on Residential Instability: Evidence From the Homelessness Prevention and Rapid Re-Housing Program

ABSTRACTMillions of individuals and families in the United States do not have access to stable housing. Recent policies in the United States and the rest of the developed world emphasize programs intended to prevent homelessness through temporary financial assistance. This article explores the impact of the largest homelessness prevention program in U.S. history, the Homelessness Prevention and Rapid Re-housing Program (HPRP), on residential instability, using a national sample of families with children enrolled in school. The identification strategy exploits variations on the location of HPRP providers. Using data on the ratio of K–12 students experiencing homelessness in school districts, we find that HPRP is associated with reductions in the percentage of homeless students for districts closer to an HPRP provider. However, the impacts of HPRP fade out when program benefits end, bringing into question whether homeless prevention can help families achieve self-sufficiency in the long run.

Permanent Housing Placement and Reentry to Services Among Family Recipients of Homelessness Prevention and Rapid Re-Housing Program (HPRP) Assistance.

The Homelessness Prevention and Rapid Re-Housing Program (HPRP) provided individuals and families who were either at-risk or currently experiencing homelessness with time-limited financial and housing support services. Evaluations of HPRP showed a high rate of family placement into permanent housing. However, little research has explored immediate and longitudinal outcomes for families enrolled in HPRP. Using Homeless Management Information System data from Indianapolis, Indiana, we examined demographic and program-related predictors of families entering permanent housing and their risk of reentry into homeless services following HPRP participation. The sample included 511 families who enrolled in the program from 2009 to 2012, with an average follow-up period of 4.5 years. We conducted analyses separately for Homelessness Prevention (HP) recipients (n = 357) and Rapid Re-Housing (RRH) recipients (n = 154). Results revealed that HP families were more likely to enter permanent housing if they: included adults who were older in age, were enrolled longer in the program, were provided rental arrear services and utility payments, and did not receive legal services. RRH families receiving rental assistance services had significantly greater odds of entering permanent housing. Among permanently housed families, at least one family member in 10.9% of HP recipients and 18.8% of RRH recipients reentered homeless services. HP families with younger children and one veteran family member were at increased risk of reentry to homelessness services. RRH recipients who did not receive moving cost services and had more children were at greater risk of reentry. Study findings suggest a need for future research on HP and RRHinterventions that identify unique service needs among families who are experiencing housing instability or homelessness.

Housing status among single adults following Homelessness Prevention and Rapid Re-housing Program participation in Indianapolis

The Homelessness Prevention and Rapid Re-housing Program (HPRP) was a federally-funded program in the United States that provided short-term financial and support services to individuals and families who were at-risk or currently experiencing homelessness. There is limited research on factors that predict placement in permanent housing following prevention and rapid rehousing interventions, particularly for single adult populations. The present study examined demographic and program-related predictors of permanent housing upon program exit among two groups of adults enrolled in HPRP in Indianapolis, IN: Homelessness Prevention (HP) recipients (n = 219) and Rapid Re-housing (RRH) recipients (n = 296). Results revealed that 76.3% of HP and 68.8% of RRH recipients were living in permanent housing when they exited HPRP. For HP recipients, completion of HPRP and outreach and engagement services were significant predictors of remaining in permanent housing. For RRH recipients, individuals who were African American, did not have a disabling condition, completed HPRP, received a greater amount of financial assistance, and received case management services had significantly greater odds of permanent housing. Findings have implications for informing short-term housing support programs for precariously housed or homeless single adults and highlight the need for future research on prevention and rehousing interventions.

Identifying Policy Levers And Opportunities For Action Across States To Achieve Health Equity.

In the United States, steps to advance health equity often take place at the state and local levels rather than the national level. Using publicly available data sources, we developed a scorecard for all fifty states and the District of Columbia that measures indicators of the use of five evidence-based policies to address domains related to health equity. The indicators are the cigarette excise tax rate, a state's Medicaid expansion status and the size of its coverage gap, percentage of four-year olds enrolled in state-funded pre-kindergarten, minimum wage level, and the presence of state-funded housing subsidy programs and homelessness prevention and rapid rehousing programs. We found that states varied significantly in their implementation of the selected policies and concluded that a variety of approaches to encourage policy changes at the state level will be needed to create healthier and more equitable communities. We describe promising, feasible state-level approaches for states to "do something, do more, do better" when they take action on the five selected policies that can promote health equity.

Predictors of homeless services re-entry within a sample of adults receiving Homelessness Prevention and Rapid Re-Housing Program (HPRP) assistance.

Local and national evaluations of the federal Homelessness Prevention and Rapid Re-Housing Program (HPRP) have demonstrated a high rate of placement of program participants in permanent housing. However, there is a paucity of research on the long-term outcomes of HPRP, and research on rehousing and prevention interventions for single adults experiencing homelessness is particularly limited. Using Homeless Management Information System data from 2009 to 2015, this study examined risk of return to homeless services among 370 permanently housed and 71 nonpermanently housed single adult HPRP participants in Indianapolis, Indiana. Kaplan-Meier survival curves were conducted to analyze time-to-service re-entry for the full sample, and the homelessness prevention and rapid rehousing participants separately. With an average follow-up of 4.5 years after HPRP exit, 9.5% of the permanently housed HPRP participants and 16.9% of those nonpermanently housed returned to homeless services. By assistance type, 5.4% of permanently housed and 15.8% of nonpermanently housed homelessness prevention recipients re-entered services, and 12.8% of permanently housed and 18.2% of nonpermanently housed rapid rehousing recipients re-entered during the follow-up period. Overall, veterans, individuals receiving rapid rehousing services, and those whose income did not increase during HPRP had significantly greater risk of returning to homeless services. Veterans were at significantly greater risk of re-entry when prevention and rehousing were examined separately. Findings suggest a need for future controlled studies of prevention and rehousing interventions for single adults, aiming to identify unique service needs among veterans and those currently experiencing homelessness in need of rehousing to inform program refinement. (PsycINFO Database Record

The impact of homelessness prevention programs on homelessness.

Despite the prevalence of temporary financial assistance programs for those facing imminent homelessness, there is little evidence of their impact. Using data from Chicago from 2010 to 2012 (n = 4448), we demonstrate that the volatile nature of funding availability leads to good-as-random variation in the allocation of resources to individuals seeking assistance. To estimate impacts, we compare families that call when funds are available with those who call when they are not. We find that those calling when funding is available are 76% less likely to enter a homeless shelter. The per-person cost of averting homelessness through financial assistance is estimated as $10,300 and would be much less with better targeting of benefits to lower-income callers. The estimated benefits, not including many health benefits, exceed $20,000.

Homelessness prevention in New York City: On average, it works

This study evaluates the community impact of the first four years of Homebase, a homelessness prevention program in New York City. Family shelter entries decreased on average in the neighborhoods in which Homebase was operating. Homebase effects appear to be heterogeneous, and so different kinds of averages imply different-sized effects. The (geometric) average decrease in shelter entries was about 5% when census tracts are weighted equally, and 11% when community districts (which are much larger) are weighted equally. This study also examines the effect of foreclosures. Foreclosures are associated with more shelter entries in neighborhoods that usually do not send large numbers of families to the shelter system.

US veterans and their unique issues: enhancing health care professional awareness.

United States veterans are a multifaceted population with a distinct culture that includes, but is not limited to, values, customs, ethos, selfless duty, codes of conduct, implicit patterns of communication, and obedience to command. Veterans experience mental health disorders, substance use disorders, post-traumatic stress, and traumatic brain injury at disproportionate rates compared to their civilian counterparts. Eighteen to 22 American veterans commit suicide daily and young veterans aged 18–44 are most at risk. Health care professionals must be aware of patients’ military history and be able to recognize suicide-risk factors, regardless of age. Advancement in medical technology has allowed servicemen to survive their injuries but, for many, at the cost of a traumatic limb amputation and associated mental scarring. Health care professionals must be able to address physical safety concerns, as well as, emotional health of veterans. Approximately 49,933 American veterans are homeless and face the same difficulties as non-veterans in addition to service-related matters. Separation from military service and issues related to complex multiple deployments are among specifically identified veteran issues. Successful veteran reintegration into civilian life rests upon providing veterans with training that builds on their military knowledge and skill, employment post-separation from service, homelessness prevention, and mental health programs that promote civilian transition. Preparing health care providers to meet the complex needs of a vast veteran population can be facilitated by implementing veteran content into curricula that includes veteran patient simulations and case studies, and utilizes veteran clinical faculty.

Predictors of Homelessness Among Families and Single Adults After Exit From Homelessness Prevention and Rapid Re-Housing Programs: Evidence From the Department of Veterans Affairs Supportive Services for Veteran Families Program

This article assesses the extent and predictors of homelessness among veterans (both veterans in families with children and single adults veterans) exiting the Supportive Services for Veteran Families (SSVF) program, which is a nationwide homelessness prevention and rapid re-housing program geared primarily toward those experiencing crisis homelessness. Among rapid re-housing participants, 16% and 26% of single adult veterans experienced an episode of homelessness at 1 and 2 years post-SSVF exit; the comparable figures at those follow-up times for veterans in families were 9.4% and 15.5%, respectively. Relatively fewer single adult veterans and veterans in families receiving homelessness prevention services experienced an episode of homelessness at 1 and 2 years post-SSVF exit. veteran-level characteristics, including age, gender, prior history of homelessness, and recent engagement with U.S. Department of Veterans Affairs (VA) health care, were generally more salient predictors of homelessness following SSVF exit than variables measuring SSVF program factors or community-level housing market conditions.